Lu Jin-Ying, Chen Kuan-Hua, Shih Shyang-Rong, Wen Fang-Yu, Wu Wan-Chen, Chen Ting-Chu, Hu Fu-Chang
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Endocr Pract. 2023 Feb;29(2):89-96. doi: 10.1016/j.eprac.2022.11.005. Epub 2022 Nov 14.
Patients with Graves' disease who remain hyperthyroid under the treatment of antithyroid drugs (ATD) or cannot tolerate ATD usually receive radioactive iodine (RAI) to control disease activity. This pilot study aimed to identify predictors of prolonged euthyroidism > 12 months after receiving RAI.
Demographic, clinical, and laboratory data from 117 patients receiving RAI were retrospectively collected, including age, gender, body surface area, smoking status, free thyroxine, thyrotropin, thyrotropin binding inhibiting immunoglobulin, microsomal antibody, thyroglobulin antibody, medication history, and thyroid volume. Only 85 patients without missing values were included in statistical analysis. The calculated RAI dose was the estimated thyroid volume × 0.4. The difference and ratio between the actual and calculated RAI doses were examined. A stepwise logistic regression analysis was conducted to identify important predictors of prolonged euthyroidism > 12 months. The cut-off values for discretizing continuous covariates were estimated by fitting generalized additive models.
Among the 85 patients on RAI, 18 (21.2%) achieved prolonged euthyroidism > 12 months, 38 (44.7%) remained hyperthyroid with decreased ATD doses, but 29 (34.1%) suffered permanent hypothyroidism and needed long-term levothyroxine. Logistic regression analysis revealed that patients with age > 66 years, 33 < age ≤ 66 years, quitting smoking vs nonsmoking or current smoking, 600 < micorsomal antibody ≤ 1729 IU/mL, 47% < thyrotropin binding inhibiting immunoglobulin ≤ 81%, 7 < thyroglobulin antibody ≤ 162 IU/mL, 0.63 < ratio between actual and calculated RAI doses ≤ 1.96, or taking hydroxychloroquine would have a higher chance of reaching prolonged euthyroidism > 12 months after receiving RAI. Its area under the Receiver Operating Characteristic (ROC) curve was 0.932.
Patients with Graves' disease who received an actual RAI dose close to the calculated RAI dose achieved prolonged euthyroidism > 12 months if they also took hydroxychloroquine during RAI treatment.
在接受抗甲状腺药物（ATD）治疗后仍处于甲状腺功能亢进状态或无法耐受ATD的格雷夫斯病患者通常接受放射性碘（RAI）治疗以控制疾病活动。这项初步研究旨在确定接受RAI治疗后甲状腺功能正常持续超过12个月的预测因素。
回顾性收集117例接受RAI治疗患者的人口统计学、临床和实验室数据，包括年龄、性别、体表面积、吸烟状况、游离甲状腺素、促甲状腺激素、促甲状腺激素结合抑制性免疫球蛋白、微粒体抗体、甲状腺球蛋白抗体、用药史和甲状腺体积。仅85例无缺失值的患者纳入统计分析。计算得出的RAI剂量为估计的甲状腺体积×0.4。检查实际RAI剂量与计算得出的RAI剂量之间的差异和比值。进行逐步逻辑回归分析以确定甲状腺功能正常持续超过12个月的重要预测因素。通过拟合广义相加模型估计连续协变量离散化的截断值。
在85例接受RAI治疗的患者中，18例（21.2%）实现了甲状腺功能正常持续超过12个月，38例（44.7%）在减少ATD剂量后仍处于甲状腺功能亢进状态，但29例（34.1%）出现永久性甲状腺功能减退，需要长期服用左甲状腺素。逻辑回归分析显示，年龄>66岁、33<年龄≤66岁、戒烟与不吸烟或当前吸烟相比、600<微粒体抗体≤1729 IU/mL、47%<促甲状腺激素结合抑制性免疫球蛋白≤81%、7<甲状腺球蛋白抗体≤162 IU/mL、实际RAI剂量与计算得出的RAI剂量之比0.63<该比值≤1.96或正在服用羟氯喹的患者在接受RAI治疗后实现甲状腺功能正常持续超过12个月的可能性更高。其受试者工作特征（ROC）曲线下面积为0.932。
接受的实际RAI剂量接近计算得出的RAI剂量的格雷夫斯病患者，如果在RAI治疗期间也服用羟氯喹，则可实现甲状腺功能正常持续超过12个月。
